Procedure for repairing foot injury

ABSTRACT

A drill guide assembly having an elongated body is configured with a first and second arm members extending from the elongated body. The second arm member is configured and adapted to be longitudinally movable along the elongated body towards and away from the first arm member for reducing fractured bones for repair. A guide housing provided on the second arm member is fitted with a removable sleeve. The removable sleeve is provided with a longitudinal bore for guiding a guide wire or a drill bit for drilling into the bones.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims the benefit under 35 U.S.C. § 119(e) of U.S.Provisional Application Ser. No. 61/057,556, filed May 30, 2008, thedisclosure of which is incorporated herein by reference in its entirety.

FIELD OF THE INVENTION

The present disclosure relates to a method and apparatus for repairingdamaged or fractured bones in the foot.

BACKGROUND

There has not been any drill alignment guide instrument for use in footand ankle soft tissues and bone repair applications. Thus, there is acontinuing need for a drill alignment guide instrument for use in footand ankle soft tissues and bone repair applications.

The mid-foot region or the medial column of the foot is comprised ofmany osseous components—distal phalanx, proximal phalanx, firstmetatarsal, medial cuneiform, intermediate cuneiform, lateral cuneiform,cuboid, navicular and talus. Bone fractures in the mid-foot regions aregenerally difficult to fixate because of the geometries of the bonesinvolved. Thus, there is a need for a guiding instrument that canprovide guidance for targeting, aligning, measuring and drilling of ahole for placement of a bone screw and then actual placement of the bonescrew while holding or compressing the bones in reduction.

SUMMARY

The orthopedic drill guide of the present disclosure provides accuratemeans for guiding the drilling through foot bones such as cuneiforms ormetatarsals to install bone screws for repairing soft tissues and bonefractures. The drill guide of the present disclosure is also configuredand adapted to provide compression of the bone pieces while alignment,guiding, measuring, drilling, and screw installation are performed. Thedrill guide can also be used for syndesmosis applications in themid-foot and distal tibia.

The drill guide assembly of the present disclosure comprises anelongated body having first and second ends, a first arm memberextending from the first end of the elongated body and a second armmember extending from the elongated body and configured and adapted tobe longitudinally movable along the elongated body. The second armmember can be moved along the elongated body in two directions, towardsor away from the first arm member. The second arm member is providedwith a guide housing at its outer end (the end away from the elongatedbody), the guide housing being configured and adapted to removablyreceive a sleeve that has a longitudinal bore for receiving a guide wire(such as Kirschner wire, also known as K-wire) or a drill bit.

Present disclosure also includes a depth gage device for measuring thedepth of a K-wire that has been drilled into a bone. The depth gagedevice comprises a cannulated elongated body having first and secondends and a bore longitudinally extending through the length of theelongated body. The bore is closed at the first end of the elongatedbody and open at the second end of the elongated body. The open secondend is configured and adapted to receive an elongated member such as theK-wire. An elongated slot opening is provided in the elongated bodyextending longitudinally over a portion of the elongated body. A pistonis provided within the bore and the piston is configured and adapted totravel in longitudinal direction within the bore. An elasticallycompressible member such as a coil spring is provided within the boreextending between the closed first end of the elongated body and thepiston. On the outer surface of the elongated body, a graduated rule isprovided along the elongated slot opening. An indicator connected to thepiston through the elongated slot opening is also provided whereby whenthe elongated member such as a K-wire is inserted into the open secondend of the elongated body, the elongated member urges the piston towardsthe closed first end of the elongated body compressing the elasticallycompressible member. As the piston moves along inside the bore, theindicator also moves along with the piston and indicates a value on thegraduated rule. The elastically compressible member keeps the piston incontact with said elongated member.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a drill guide assembly according to anembodiment of the present disclosure.

FIG. 1A is a perspective view of an embodiment of a guide housing.

FIG. 2 is a plan view of the drill guide assembly of FIG. 1.

FIG. 3 is a side view of the drill guide assembly of FIG. 1.

FIG. 4 is an end view of the drill guide assembly of FIG. 1.

FIG. 4A is a detailed view of the region B in FIG. 4.

FIG. 5 is a perspective view of an example of a removable sleeve for usewith the drill guide assembly of the present disclosure.

FIG. 6 is a side view of the removable sleeve of FIG. 5.

FIG. 7 is an end view of the removable sleeve of FIG. 5.

FIG. 8 is a top view of the removable sleeve of FIG. 5.

FIG. 9 is a cross-sectional view of the removable sleeve through theline A-A shown in FIG. 8.

FIG. 10 is a side view of the drill guide assembly of FIG. 1 with theremovable sleeve of FIG. 5 inserted into the guide housing of the drillguide assembly.

FIG. 11 is a cross-sectional view of the guide housing and the removablesleeve assembly through the line A-A shown in FIG. 10.

FIG. 12 is a cross-sectional view of the drill guide assembly of FIG. 1.

FIG. 13 is a cross-sectional view of the drill guide assembly of FIG. 1through the line B-B shown in FIG. 3.

FIG. 14A is a perspective view of a depth gage device according to anaspect of the present disclosure.

FIG. 14B is a top view of the depth gage device of FIG. 14A.

FIG. 14C is a cross-sectional view of the depth gage device takenthrough the line A-A shown in FIG. 14B.

FIG. 14D is a detailed view of the area B identified in FIG. 14C.

FIG. 14E is a perspective view of an elastically compressible member 70of the depth gage device of FIG. 14A.

FIG. 14F is a plan view of the depth gage device of FIG. 14A in use inconjunction with the drill guide assembly of FIG. 1.

FIG. 14G is a perspective view of another embodiment of the depth gagedevice.

FIG. 15 is a perspective view of a blunt trocar that can be used inconjunction with the drill guide assembly of the present disclosure.

FIG. 16 is a plan view of a drill guide assembly according to anotherembodiment of the present disclosure.

FIG. 17 is a cross-sectional view through the line C-C shown in FIG. 16.

FIG. 18 is a top view of the drill guide assembly of FIG. 16.

FIG. 19 is a cross-sectional view through the line A-A shown in FIG. 18.

FIG. 20 is a detailed view of the area B identified in FIG. 19.

FIG. 21 is a perspective view of a handle for use in conjunction withthe drill guide assembly of the present disclosure.

FIG. 22 is a plan view of the handle of FIG. 21.

FIGS. 23 and 24 are cross-sectional views taken through the lines A-Aand B-B shown in FIG. 22, respectively.

FIG. 25 is a side view of the clamp of FIGS. 16 and 21 operably engagedwith the drill guide assembly of the present disclosure.

FIG. 26 is a flowchart of the method according to one embodiment of thepresent disclosure.

FIGS. 27A-27F are photographs illustrating the various interim steps ofthe method of FIG. 26.

FIG. 28 is a schematic illustration of a surgical drill guide kitincluding the drill guide assembly of the present disclosure.

The features shown in the above referenced drawings are illustratedschematically and are not intended to be drawn to scale nor are theyintended to be shown in precise positional relationship. Like referencenumbers indicate like elements.

DETAILED DESCRIPTION

This description of the exemplary embodiments is intended to be read inconnection with the accompanying drawings, which are to be consideredpart of the entire written description. In the description, relativeterms such as “lower,” “upper,” “horizontal,” “vertical,”, “above,”“below,” “up,” “down,” “top” and “bottom” as well as derivative thereof(e.g., “horizontally,” “downwardly,” “upwardly,” etc.) should beconstrued to refer to the orientation as then described or as shown inthe drawing under discussion. These relative terms are for convenienceof description and do not require that the apparatus be constructed oroperated in a particular orientation. Terms concerning attachments,coupling and the like, such as “connected” and “interconnected,” referto a relationship wherein structures are secured or attached to oneanother either directly or indirectly through intervening structures, aswell as both movable or rigid attachments or relationships, unlessexpressly described otherwise.

FIGS. 1-4 illustrate a drill guide assembly 100 according to anembodiment. The drill guide assembly 100 comprises an elongated body 102having a first end 103A and a second end 103B. A first arm member 106extends from the first end 103A of the elongated body 102. A modularsecond arm member 110 extends from the elongated body 102 and isconfigured and adapted to be longitudinally movable along the elongatedbody in two directions, towards or away from the first arm member 106.The second arm member 110 is referred to as being modular because it isformed from a piece separate from the elongated body 102. The second armmember 110 is provided with a guide housing 116 at its outer end (theend away from the elongated body 102). The guide housing 116 has asleeve-receiving hole or a bore 117 for removably receiving a sleeve 20(see FIGS. 5 and 10).

The lengths of the first arm member 106 and the second arm member 110are matched so that the guide housing 116 and the tip 108 of the firstarm member 106 align as shown. This alignment allows a K-wire or a drillbit inserted through the removable sleeve 20 positioned in the guidehousing 116 to contact the tip 108 when the K-wire or the drill bit isextended towards the first arm member 106. This will be discussedfurther in connection with the various examples of surgical proceduresfor using the drill guide assembly. As shown in FIG. 2, an alignmentnotch 119 may be optionally provided on the tip 108 of the first armmember 106. The location of the alignment notch 119 is such that thelongitudinal axis A of the guide housing 116 aligns with the alignmentnotch 119.

According to another embodiment, the guide housing 116 can be providedon the first arm member 106 rather than on the second arm member. Inthat embodiment, the outer end of the second arm member 110 would looklike the tip 108 of the first arm member 106 shown in FIG. 1 and thealignment notch 119 would be provided on the second arm member 110.

The second arm member 110 has a base portion 112 that is configured andadapted to engage the elongated body 102 to allow the longitudinalmovement of the second arm member 110 along the elongated body 102towards and away from the first arm member 106. In one preferredembodiment, the elongated body 102 is four-sided having a generallyrectilinear cross-section. The base portion 112 is provided with amatching rectilinear shaped through-hole 114 for receiving the elongatedbody 102. This arrangement prevents the second arm member 110 fromrotating about the elongated body 102 and helps maintain the alignmentbetween the first arm member 106 and the second arm member 110 discussedabove.

As shown in FIGS. 3 and 4, in one preferred embodiment, one corner ofthe elongated body 102 is provided with a chamfer 102A so that thefour-sided rectilinear cross-section of the elongated body 102 has achamfered corner. FIG. 4A shows a detailed view of the region B in FIG.4 with the body 102 of the drill guide assembly removed from therectilinear shaped through-hole 114 of the base portion 112. Thethrough-hole 114 is provided with a truncated corner 114A for aligningwith the chamfer 102A of the body 102. The chamfer 102A provides theelongated body 102 with a lateral cross-sectional shape that isnon-symmetric. This feature makes the assembly of the two modularcomponents, the elongated body 102 and the second arm member 110,orientation sensitive. This feature ensures that the second arm member110 is always in the correct orientation when the second arm member 110is assembled with the body 102. The chamfer 102A functions as anorientation key. The orientation function can also be achieved with avariety of cross-sectional shapes for the elongated body 102 with orwithout a chamfer as long as the cross-sectional shape is asymmetric,such as a trapezoid. In the illustrated example, the lateralcross-sectional shape of the elongated body 102 and the correspondingthrough-hole 114 of the base portion 112 have rectilinear shape.However, other variations in the cross-sectional shape of the elongatedbody 102 that would provide the non-symmetry without substantiallyaltering the other functions of the drill guide assembly is within thescope of the present disclosure.

The base portion 112 and the elongated body 102 are configured andadapted to operably engage each other so that the longitudinal movementof the second arm member 110 along the elongated body 102 is ratcheted.Ratchet teeth 104 are provided on one of the sides of the elongated body102. The base portion 112 comprises a spring-loaded mechanism thatcooperates with the ratchet teeth 104 and allows the second arm member110 to be moved along the elongated body 102 in one direction, towardsthe first arm member 106, but prevents the second arm member 110 frombacking out in the opposite direction, away from the first arm member106. To move the second arm member 110 away from the first arm member106, the spring-loaded mechanism must be unlocked. An example of thespring-loaded mechanism will be described in more detail in conjunctionwith FIG. 18.

Because the drill guide assembly 100 is used to grasp a piece of bone orcompress two or more pieces of soft tissues or bones between the two armmembers in order to align and drill a hole for a bone screw, the guidehousing 116 and the tip 108 of the first arm member 106 are configuredand adapted to provide a good grip on the bone. In one embodiment, thetip 108 of the first arm member 106 terminates in a sharp point that canbe used to penetrate the soft tissue covering the bone and also dig intothe bone surface and help anchor the first arm member. The tip 108 canalso be curved towards the second arm member 110 as shown in theembodiments of FIGS. 1, 10 and 12. This curvature allows the tip 108 tobe wrapped around a bone if appropriate. On the guide housing 116, oneor more spikes 118 can be provided on the side of the guide housing 116facing the first arm member 106. The one or more spikes 118 extendlongitudinally towards the first arm member 106 and terminate in a sharppoint to dig into the bone surface and/or soft tissues. The length andnumber of the spikes 118 provided on a particular drill guide assemblycan be varied to meet the requirements of the particular intendedapplication. Preferably, the one or more spikes 118 are positioned onthe guide housing 116 so that the spike(s) do not interfere with theK-wire or the drill bit that would be inserted through the guide housing116.

Referring to FIG. 1A, according to another embodiment, the guide housing116 can be provided with one or more holes 116a for fixating theinstrument to a bone using K-wires or screws. The holes 116a preferablyextend through the guide housing 116 longitudinally.

During actual use, an external imaging method will generally be used toverify the position and alignment of the drill guide assembly withrespect to the bone. External imaging method can include currentlyavailable technologies such as X-ray radiography, fluoroscopy, etc. andyet to be developed external imaging technologies. To enable thisverification by external imaging such as X-ray radiography andfluoroscopy, in one preferred embodiment, the elongated body 102 of thedrill guide assembly is made from a radiolucent material. One example ofsuch material suitable for this application is polyetheretherketone(PEEK) thermoplastic polymer. Glass filled PEEK and carbon filled PEEKare some examples. When such polymer is used for the body 102, the body102 must have appropriate thickness so that the body 102 has sufficientstiffness. Aluminum alloys can also be radiolucent if it is thin enough.The first arm member 106 can also be radiolucent but in one preferredembodiment, at least the tip portion 108 of the first arm member 106 ismade to be radiopaque (i.e. made of metal) so that the tip 108, theguide housing 116 and the K-wire, for example, are visible in X-rayradiography in order to properly verify and confirm the alignment of theK-wire and the position of the drill guide. In an embodiment where thefirst arm member 106 is made of a metal and the elongated body 102 ismade of a radiolucent polymer, the first arm member 106 would bemechanically joined to the body. For example, in the embodiment shown inFIG. 12, the first arm member 106 is joined to the body 102 by a screw109.

FIGS. 5-9 illustrate an example of the sleeve 20 for removably insertinginto the guide housing 116 of the drill guide assembly 100. The sleeve20 has a generally cylindrical body 21 that is inserted into thesleeve-receiving hole 117. The sleeve 20 has a central bore 23longitudinally extending through the full length of the sleeve 20. Thebore 23 is centrally located in the sleeve 20 such that when the sleeve20 is inserted into the guide housing 116, the longitudinal or centralaxis of the bore 23 coincides with the longitudinal axis A of the guidehousing 116. If the sleeve 20 is a K-wire sleeve used to guide a K-wire,the diameter of the bore 23 is matched to that of the particular K-wire.If the sleeve 20 is a drill sleeve used to guide a drill bit, thediameter of the bore 23 is matched to that of the particular drill bit.In one preferred embodiment, the sleeve 20 is provided with a flaredhead portion 22 at the top end that can act as a stop when the sleeve 20is inserted into the guide housing 116.

The sleeve 20 can also have a retention tab 24 extending downward fromthe flared head portion 22 that cooperates with the guide housing 116for retaining the sleeve 20 in place and prevent the sleeve 20 fromfalling or sliding out of the guide housing 116. As illustrated in FIGS.6, 8 and 9, the retention tab 24 is provided with a spring-loaded detent27 that protrudes from the inner surface 25 of the retention tab 24. Thespring-loaded detent 27 urges against the guide housing 116 and retainsthe sleeve in place. The detent 27 can be spring-loaded inside theretention tab 24 as shown in the detailed view of FIG. 9. Thespring-loaded detent 27 and a compressible member 28 such as a coilspring and steel ball are held within a cavity 26 by a set screw 29.

In one preferred embodiment, a groove 115 is provided on the outersurface of the guide housing 116 to cooperate with the spring-loadeddetent 27 as shown in FIGS. 1 and 2. When the sleeve 20 is fullyinserted into the guide housing 116, the spring-loaded detent 27 isextended into the groove 115 and prevents the sleeve 20 fromunintentionally falling out of the guide housing 116. This arrangementis shown in the assembled views of FIGS. 10 and 11. The sleeve 20 can beremoved by simply pulling it out using some force to compress thespring-loaded detent 27. In other embodiments, the groove 115 can bereplaced with other structures such as indentations that will providethe same function as the groove 115 of receiving the spring-loadeddetent 27.

Referring to FIGS. 12 and 13, in another example, the guide housing 116and the sleeve 20 can be configured and adapted to prevent the sleeve 20from rotating within the guide housing 116. The sleeve 20 can beprovided with an alignment tab 32 on its outer surface of the sleevebody 21 and the guide housing 116 can be provided with correspondinggrooves 132 running longitudinally along the inner surface of thesleeve-receiving hole 117.

FIG. 13 is an illustration of a cross-section taken through the ratchetengaging portion 113 of the base 112 of the second arm member 110showing the details of an example of a ratcheting mechanism between thesecond arm member 110 and the elongated body 102. The elongated body 102of the drill guide 100 extends through the base 112 as shown. Inside theratchet engaging portion 113, a button 130 having a through hole 134 foraccommodating the elongated body 102 is provided. The button 130 isconfigured to move up and down in perpendicular direction to the ratchetteeth 104 surface of the elongated body 102. In this example, slots 133in the button 130 cooperate with the button guide pins 170 to limit theup and down travel of the button within the ratchet engaging portion113. A top side 130A of the button 130 is exposed and protrudes from theratchet engaging portion 113. The bottom side 130B of the button resideswithin the ratchet engaging portion 113 and a coil spring 180 positionedbetween the button 130 and the ratchet engaging portion 113 urgesagainst the bottom side 130B of the button. This keeps the bottomsurface (in the orientation shown in FIG. 13) of the through hole 134pushed up against the ratchet teeth 104 when in a resting position. Theratchet teeth 104 are oriented in one direction such that when thesecond arm member 110 is pushed towards the first arm member 106, thebutton 130 will slide over the ratchet teeth 104 while preventing thesecond arm member 110 to be moved away from the first arm member 106. Tomove the second arm member 110 away from the first arm member 106, thebutton 130 has to be pressed down (in the orientation shown in FIG. 13)thus disengaging the button 130 from the ratchet teeth 104. Thestructure described herein is just one example of a ratcheting mechanismthat can be implemented to engage the base 112 of the second arm member110 to the elongated body 102 of the drill guide assembly.

Referring to FIGS. 14A-14F, a depth gage 60 for use in conjunction withthe drill guide of the present disclosure will be described. The depthgage 60 is used to measure the depth of the K-wire 400 (see FIG. 14F)drilled into the bone to determine the proper length of the bone screw.After the K-wire 400 is drilled into the bone with the drill guide inplace, the depth gage 60 is slid over the remaining portion of theK-wire 400 that is not drilled into the bone and the depth gage 60readily tells the surgeon the depth of the K-wire's penetration into thebone.

In one embodiment, the depth gage 60 comprises a hollow elongated body61 having an opening at one end 63 for receiving an elongated member,the K-wire 400 having a length. A spring-loaded piston 72 is providedwithin the hollow elongated body 61 for urging against the K-wire 400received in the opening at one end 63 of the hollow elongated body. Whenthe K-wire 400 is received into the opening and pushes the spring-loadedpiston 72 away from the opening, the distance traveled by thespring-loaded piston 72 provides an indication about the length of theK-wire 400. Specifically, in the application described herein, bysliding the depth gage 60 over the K-wire until the leading end 63 ofthe depth gage 60 contacts the bone surface, the distance traveled bythe spring-loaded piston 72 indicates the length of the portion of theK-wire 400 that is drilled into the bone. Thus the depth of the bonedrilled by the K-wire 400 is measured.

In another embodiment, the depth gage 60 comprises a cannulatedelongated body 61 having a first end 62 and a second end 63 and a bore64 longitudinally extending through the length of the elongated body 61.The bore 64 is closed at the first end 62 of the elongated body and openat the second end 63 of the elongated body, the open second end 63 beingconfigured and adapted to receive an elongated member such as a K-wire.A pair of elongated slot openings 66 are provided in the elongated bodydiametrically opposed from one another and extend longitudinally over aportion of the elongated body 61. FIG. 14A shown one of the two throughslots 66 on the near-side of the depth gage 60. The other slot openingwould be on the opposite side of the depth gage 60, the side not visiblein the FIG. 14A view.

A piston 72 is provided within the bore 64 and is configured to travelin longitudinal direction within the bore. An elastically compressiblemember 70 is also provided within the bore 64 and extends between theclosed first end 62 of the elongated body and the piston 72. The piston72 and the compressible member 70 can be attached to one another butthis is not necessary. As shown in FIG. 14E, the piston 72 can beprovided with a pair of guide pins 73. The guide pins 73 extend into theslot openings 66 for guiding the piston as it is slides longitudinallywithin the bore 64. The guide pins 73 can be a single pin that is placedthrough the piston 72 as shown in FIG. 14E.

At the first end 62 of the depth gage, the bore 64 is closed off toprevent the elastically compressible member 70 from falling out throughthat end. The bore 64 can be closed off in a variety of possible ways.In one example shown in FIGS. 14A-14C, a stopping pin 68 placed throughthe body 61 of the depth gage 60 blocks the first end 62.

A graduated rule 65 is provided on the outer surface of the elongatedbody along said elongated slot opening 66. In the embodiment of thedepth gage 60 shown in FIG. 14A, the graduated rule 65 is provided on aflat surface of the elongate body 61.

A sliding indicator 67 is provided for reading the measurement from thegraduated rule 65 which indicates the length of an elongated member suchas a K-wire that is drilled into the bone. The sliding indicator 67 isconfigured and adapted to cooperate with the piston 72 to move alongwith the piston 72 as the piston 72 moves inside the bore 64. Thesliding indicator 67 can be connected to the piston 72 by the guide pins73 as shown in FIG. 14A. The guide pin 73 is fitted through holes in thesliding indicator 67. The guide pin 73 extends from one side of thesliding indicator 67 through the slot openings 66 and the piston 72 andout to the other side of the sliding indicator 67, thus, connecting thesliding indicator 67 to the piston 72 residing within the bore 64. Asthe piston moves up and down within the bore 64, the sliding indicator67 follows along from the outside of the depth gage 60. The slidingindicator 67 can be provided with at least one marker 67B for indicatinga reading along the graduated rule 65. In the particular embodimentshown in FIG. 14A, the sliding indicator 67 is provided with a window67A and a pair of markers 67B are provided to indicate the measurementon the graduated rule 65 shown through the window 67A.

The bore 64 can be defined into two portions, a front portion 64A and aback portion 64B. The front portion 64A is where an elongated member,such as a K-wire, is received for measurement and the inside diameter ofthe front portion 64A is appropriately matched to the diameter of theintended elongated member. The back portion 64B is where the elasticallycompressible member 70 and the piston 72 reside. Thus, the insidediameter of the back portion 64B is appropriately matched to thediameter of the elastically compressible member 70 and the piston 72.Where the diameter of the elastically compressible member 70 and thepiston 72 are larger than the diameter of the front portion 64A, theinside diameter of the back portion 64B will be larger and there will bea transition portion 64C where the diameters change. (See FIG. 14D). Thetransition portion 64C can act as a stop for the piston 72 defining itsresting position.

As discussed above during the description of the surgical procedures,after a K-wire is drilled into a bone to a certain depth using the drillguide, the depth gage 60 can be used to measure the length of the K-wirethat is inside the bone. This measurement is necessary to determine theproper length of a bone screw that will be used after the K-wire isremoved and a hole is drilled into the bone.

As shown in FIG. 14F, to measure the depth of the K-wire 400 inside thebone pieces 501 and 502, the open end of the depth gage 60 at the secondend 63 is slid over the portion of the K-wire that is remaining outsidethe bone until the leading tip of the depth gage 60 contacts the bone.The K-wire 400 extends into the bore 64 contacts the piston 72 andpushes the piston 72 back until the depth gage 60 contacts the bonesurface and cannot be advanced further. The elastically compressiblemember 70, which can be a coil spring or some other suitable component,urges the piston 72 against the K-wire and helps the piston 72constantly maintain the contact with the K-wire 400. This feature allowsthe depth gage 60 to be used accurately and easily in any orientation.

Because the overall length of the K-wire 400 is known and the distancefrom the leading tip of the depth gage 60 to the resting position of thepiston 72 is also known, the graduated rule 65 can be calibrated toprovide the length of the portion of the K-wire that is drilled into thebone. Alternatively, the graduated rule 65 can be calibrated to providethe length of the K-wire that is remaining outside the bone in whichcase the surgeon can subtract that figure from the known total length ofthe K-wire to determine the length of the K-wire that is drilled intothe bone.

FIG. 14G shows a depth gage 160 according to another embodiment. Thedepth gage 160 functions the same way as the depth gage 60 shown in FIG.14A. The depth gage body 61 is provided with a longitudinally extendingbore 64. To measure the depth of a K-wire, the front end 63 of the depthgage is slipped over the K-wire portion that remains outside a bone.Inside the depth gage 60 is provided with the piston 72 and theelastically compressible member 70. The piston's sliding movement withinthe depth gage 160 is guided by the slot opening 66. The slot opening isoriented in longitudinal direction and a graduated rule 65 is providedalong the slot opening 66. But unlike in the depth gage 60, in thisembodiment, the slot opening 66 and the graduated rule 65 are on thesame side of the body 61. The sliding indicator 67 connected to thepiston 72 via the guide pin 73 (not visible in FIG. 14G) moves along thegraduated rule following the piston's movement and thus indicating ameasurement that correlates with the length of the K-wire drilled intothe bone pieces.

FIG. 15 shows a blunt trocar 80 for use with the drill guide assembly.The blunt trocar 80 can be used in conjunction with the drill-guidingsleeve 20 to verify the entry point for the drill. The trocar 80comprises a blunt tip 82 and a plurality of grooves 83 can be providedon the body of the trocar to enhance gripping by the user. After thedrill guide assembly is secured into a desired position around a repairsite, the blunt trocar 80 can be inserted into the drill-guiding sleeve20 and advanced until the blunt tip 82 contacts the surface to bedrilled. The point of contact represents the drill entry point. Then,X-ray can be used to verify that the location of the drill entry pointis correct. Alternatively, the blunt trocar 80 can have a diameter thatis same as the outer diameter of the sleeve 20 in which case, the blunttrocar 80 can fit directly into the guide housing 116 and can be usedwithout the drill-guiding sleeve 20.

FIGS. 16-20 show a drill guide assembly 200 according to anotherembodiment. In this embodiment, the one or more spikes 118 are providedon a base member 220, the base member 220 configured and adapted torotatably engage the guide housing 116. FIG. 17 shows the detailedstructure of the spike base member 220. The base member 220circumscribes the end of the guide housing 116 that is closer to thefirst arm member 106 and is rotatable about the longitudinal axis of theguide housing 116. The base member 220 is rotated to adjust the locationof the one or more spikes 118. The base member 220 is provided with ahole 223 that aligns with the sleeve-receiving hole 117 of the guidehousing 116. The base member 220 is also provided with means forsecuring the base member onto the guide housing 116. For example, in theembodiment shown in FIG. 17, one or more set screws 222 are tapped intothe side of the base member 220 to hold the base member 220 in place.The guide housing 116 is provided with a groove or indentations tocooperate with the set screws 222. The base member 220 can be locked inplace by tightening the set screws 222. Optionally, by adjusting the setscrews 222, the base member 220 can be allowed to freely rotate withoutdisengaging from the guide housing 116. In another example,spring-loaded detents and pins can be provided in place of the setscrews 222. The spring-loaded detents and pins would also allow the basemember 220 to freely rotate without disengaging from the guide housing116. As shown in FIG. 19, the outer surface of the base member 220 canbe provided with a plurality of tabs 224 to help with turning the basemember 220. FIG. 20 shows the same ratcheting mechanism structure shownin FIG. 13 and described in conjunction with the drill guide assembly100.

FIGS. 21-25 show an example of a clamp 300 that can be used to assist inthe bone reduction using the drill guide assemblies of the presentdisclosure. The clamp 300 is generally constructed like a pair of pliersand comprises handles 302 connected by a hinge 303. The operable ends305 of the clamp 300 are configured to engage the drill guide assemblies100, 200 to assist compressing the first and second arm members 106 and110 together for bone reduction.

Referring to FIGS. 3, 12 and 18, the drill guide assemblies 100 and 200are provided with clamp engaging holes 141, 142. The first hole 141 isprovided near the first end 103A of the elongated body 102. The secondhole 142 is provided on the base 112 of the second arm member 110. Eachof the two operable ends 305 of the clamp 300 are provided with a pin312. The pins 312 are inserted into the holes 141 and 142 of the drillguide assembly as shown in FIG. 25. Closing the handles 302 willcompress the second arm member 110 towards the first arm member 106.

In one preferred embodiment, the operable ends 305 are configured tohave an articulated end 310 that pivots about the hinge 320. Thedetailed cross-sectional views of the articulated ends 310 in FIGS. 23and 24 show that a spring loaded ball 340 can be provided between thearticulated ends 310 and the operable ends 305 to register thearticulated ends 310 into certain predefined positions. This can behelpful in inserting the pins 312 into the receiving holes 141, 142 bykeeping the articulated joint somewhat rigid. A coil spring 330 and theball 340 can be provided within a chamber 314 inside the articulated end310. The operable ends 305 can be provided with terminal ends 306 thatengage the ball 340 to register the position of the articulated ends310. The terminal ends 306 can be configured with one or more indents toregister ball 340 as the articulated ends 310 are pivoted.

Referring to FIG. 12, each of the clamp engaging holes 141 and 142 canbe provided with a locking ring 145 that will cooperate with grooves312a (see FIGS. 23 and 24) on the pins 312 to lock the clamp 300 intothe holes 141 and 142 to prevent the clamp 300 from disengaging from thedrill guide assembly unintentionally.

Referring to FIG. 28, in another embodiment, the drill guide assembly100 can be provided as part of a surgical drill guide kit 800 containingall necessary accessories and parts. One embodiment of a surgical drillguide kit comprises the drill guide assembly 100, one or more sleeves 20(some of which can comprise K-wire guiding sleeves for receiving varioussizes of K-wires and drill-guiding sleeves for receiving various sizesof drill bits), one or more K-wires 400 of varying sizes, one or morebone screws 600 of varying sizes, a depth gage 60, a blunt trocar 80,and a clamp 300. The surgical drill guide kit 800 can also include otherimplants such as one or more bone plates 700 of appropriate sizes andconfigurations. The components of the kit 800 are preferably arranged ina convenient format, such as a surgical tray or a case. However, the kitcomponents do not have to be packaged or delivered together, providedthat they are assembled or collected together in the operating room foruse at the time of surgery.

According to another aspect of the present disclosure, an example of asurgical procedure for using the disclosed drill guide assembly will bedescribed. An example of such surgical procedure is aligning anddrilling a hole for a bone screw to repair fractured bones or secure twoadjacent bones to repair damaged soft tissues (e.g. ligaments) in themid-foot region, such as a Lisfranc foot injury.

An embodiment of the procedure for repairing a Lisfranc foot injury willbe described referring to FIG. 26 and FIGS. 27A-27F. FIG. 26 shows aflowchart 500 of the method described herein. [Exposure/JointPreparation]—Depending on the degree of injury and instability, one ortwo dorsal longitudinal incisions are made to gain access to the injurysite (see FIG. 27A and block 501 of FIG.26). The first incision is madebetween the first and second metatarsal bases (FIG. 27A) and the secondincision is made parallel to the first between the third and fourthmetatarsal bases. Care should be taken to protect the sensory branchesof the superficial peroneal nerve. Typically a small avulsion fracturecan be seen at the medial base of the second metatarsal where theLisfranc ligament attaches. Any small free pieces of cartilage should beremoved and joint surfaces debrided if arthrodesis is desired.

[Reduction]—The drill guide assembly 100 is used to maintain thereduction between the second metatarsal and the medial cuneiform. Thefirst and second arm members 106, 110 of the drill guide assembly areplaced around the second metatarsal and the medial cuneiform.Specifically, the hook-shaped tip portion 108 of the first arm member106 is placed between the second and third metatarsal base. Thetargeting area (drilling point) placement on the medial cuneiform isdetermined using the spike 118 component of the second arm member 110before fully reducing the Lisfranc joint. The targeting of the drillingpoint is done by moving the second arm member 110 towards the first armmember 116 until the spike 118 is placed on the medial side of themedial cuneiform in the general location where the bone is to be drilled(see FIG. 27B and block 502 of FIG. 26). Next, the placement of thedrill guide assembly 100 can be optionally verified by using the blunttrocar 80 and an external imaging as described above and adjusted ifnecessary (see block 503 of FIG. 26). Once the placement of the drillguide assembly 100 is finalized, the drill guide assembly 100 is used toreduce the Lisfranc joint by closing the two arm members 106, 110together (see block 504 of FIG. 26). Generally, this compression can bedone by hand and the ratcheting mechanism of the second arm member 110aids in achieving the desired reduction of the bones. If necessary,however, additional compression force may be gained by the use of theclamp 300.

[K-wire placement]—Next, a K-wire guiding sleeve 20 is inserted into theguide housing 116 and a 1.6 mm K-wire is inserted into the sleeve's bore23 and drilled through the medial cuneiform and the second metatarsaluntil an external imaging shows the K-wire touching the tip 108 of thefirst arm member 106 on the lateral side of the second metatarsal (seeFIG. 27C and block 505 of FIG. 26). Preferably, the position of theK-wire is verified by an external imaging in AP and lateral views (seeblock 506 of FIG. 26).

[Screw length determination]—Next, with the K-wire in place, the K-wireguiding sleeve 20 is removed and a depth gage 60 is inserted through theguide housing 116 and over the K-wire to measure the depth of the K-wireinside the bone (see FIG. 27D and block 507 of FIG. 26). The measureddepth of the K-wire is the length of the bone screw to be used.

[Hole preparation]—A drill-guiding sleeve 20 is then placed in the guidehousing 116 and a cannulated drill is used to pre-drill over the K-wirefor screw placement (see FIG. 27E and block 508 of FIG. 26). Asdiscussed before, the K-wire sleeve and the drill sleeve are essentiallythe same except that the drill sleeve has a larger diameter bore 23. Thedrill should be of the appropriate diameter for the bone screw that willbe used and the diameter of the bore 23 in the drill sleeve should beappropriate size for the drill to ensure proper centering of the drill.If a 3.7 mm screw is to be used, a 2.6 mm cannulated drill is used forthe pre-drill. If a 4.5 mm screw is to be used, then a 3.2 mm cannulateddrill is used. If arthrodesis or lagging of the screw is desired, theappropriate overdrill (3.7 mm or 4.5 mm) is required to the desireddepth. If head countersinking is required, the head drill must be usedafter the depth gage measurement is made. With the drill bit in thebone, an external imaging can be used to verify that proper depth wasdrilled (see block 509 of FIG. 26).

[Screw placement]—Once the bone is drilled, the drill bit, the K-wireand the drill-guiding sleeve are removed. At this point, the drill guideassembly 100 is still keeping the bones in reduction and a bone screw ofappropriate diameter is screwed into the bones through the hole 117 inthe guide housing 116 until the bone screw is fully seated on the medialcuneiform (see FIG. 27F and block 510 of FIG. 26). If the bonedetermined to be soft and additional stability is required for the headof the screw, a washer may be placed on the screw prior to insertion.The screw is inserted utilizing the 2.5 mm hex driver for the 3.7 mmscrews and the 3.5 mm hex driver for the 4.5 mm screws. Once the bonescrew is in place, the drill guide assembly 100 is removed by releasingthe ratcheting mechanism (see block 511 of FIG. 26).

Although the drill guide assembly 100 of the present disclosure isconfigured and adapted to be well suited for the Lisfranc injury repairprocedure described above, the drill guide assembly 100 can be used toreduce and install bone screws through fractured bone pieces generally.For example, the drill guide assembly 100 can be used in the repair ofbone fractures in the ankle, wrist, etc. The dimensions of the variouscomponents of the drill guide assembly 100 can be appropriately variedto accommodate different sizes of the bones involved.

Although the invention has been described in terms of exemplaryembodiments, it is not limited thereto. Rather, the appended claimsshould be construed broadly, to include other variants and embodimentsof the invention, which may be made by those skilled in the art withoutdeparting from the scope and range of equivalents of the invention. Thescope of the invention disclosed herein is to be limited only by thefollowing claims.

1-41. (canceled)
 42. A depth gage comprising: a hollow body having anopening at one end for receiving a member having a length; aspring-loaded piston provided within said hollow body and arranged so asto urge said member through said opening, wherein when the member isinserted into said opening so as to push the spring-loaded piston awayfrom said opening, the distance traveled by the piston provides anindication of the length of the member located outside the depth gage.43. The depth gage of claim 42, wherein said member is a K-wire.
 44. Thedepth gage of claim 42, wherein the piston is located within a boredefined by the hollow body so as to be configured to travel inlongitudinally the bore.
 45. The depth gage of claim 44, wherein anelastically compressible member is located within the bore so as toextend between a closed end of the hollow body and the piston.
 46. Thedepth gage of claim 45, wherein the piston and the compressible memberfixed to one another.
 47. The depth gage of claim 44, wherein the pistonincludes a pair of guide pins that project into the openings 66 forguiding the piston as it is slides longitudinally within the bore. 48.The depth gage of claim 44, wherein a guide pin is disposed through thepiston.
 49. The depth gage of claim 45, wherein the bore is closed offby a pin located within the bore so as to prevent the elasticallycompressible member from falling out through that end.
 50. A depth gagecomprising: a cannulated body having first and second ends and a borelongitudinally extending through the length of the body; wherein saidbore is closed at said first end and open at said second end, said opensecond end sized to receive a member; a slot defined by the body, saidslot extending longitudinally over a portion of the body; a pistonprovided within said bore configured to travel in longitudinal directionwithin said bore; an elastically compressible member provided withinsaid bore extending between said closed first end of the body and saidpiston; a graduated rule provided on the body's outer surface along saidslot opening; an indicator connected to said piston through said slotwhereby when a member is inserted into said open second end and urgessaid piston towards the closed first end of the body compressing saidelastically compressible member, said indicator moves along with thepiston and indicates a value on the graduated rule, wherein theelastically compressible member keeps the piston in contact with saidmember.